Health reform and one man's struggle

Hansen, 28, has no health insurance. He worked for years as a waiter, but the restaurant didn't provide coverage, and he couldn't afford a policy on his own pay as a waiter.

Then, in 2007, Hansen was diagnosed with Type 1 diabetes. Every health insurer turned him down for coverage. His out-of-pocket costs for diabetes treatment, meanwhile, run into the thousands of dollars per year.

As health reform heats up in Washington, D.C., and across America, policy wonks and politicians are debating how to pay for an overhaul, and what role that government will play.

Beneath the rhetoric, though, lies a vital but often-overlooked feature of reform: Proposed legislation would prohibit health insurers from rejecting people who have pre-existing medical conditions, anything from cancer to rheumatoid arthritis.

America's Health Insurance Plans, a major trade group, has agreed that if everyone is required to have insurance, the industry would no longer refuse to cover people with chronic conditions. And no longer would insurers charge a person higher premiums based on their health status. Those changes would hit Hansen's sweet spot.

He now owns the restaurant he used to work for, a barbecue place in Holly Hill, Fla. The business is just breaking even. His condition, though, remains a constant financial worry.

Hansen has pursued creative ways to save money.

Buying two bottles of insulin would normally cost him a total of $375 per month, but Hansen found a pharmacy online to buy them from Canada, where prices are much lower: $120 per month.

He purchases his diabetes test strips also online, through a wholesaler, at $60 for 100 strips. He uses eight to 10 a day to check his blood sugar. Then there are needles and alcohol swaps to buy.

"That's just basic survival,'' he says.

Still, Hansen hasn't seen a physician in more than a year. A doctor visit, along with the bloodwork, would cost him at least $500 every three or four months, he says.

"I'm rolling the dice.'' he says. "Hopefully nothing is wrong with me.'' He recently used a $20 home kit to do an A1c blood glucose test. "My body hurts a lot,'' he says.

When he took over the restaurant and sought group insurance for himself, his wife and children, and three managers, the cost was $2,200 a month, with a high deductible. And it wouldn't cover any of his diabetes care for a year. After that, it would cover only 20% of his insulin cost.

The National Federation of Independent Business, a trade group, says that while it opposes some reform proposals, ending insurance discrimination practices against people with chronic disease would be a big help to small firms.

Health reform could mean Hansen obtaining insurance at an affordable rate as an individual. Reform could mean buying a reasonably-priced employer plan as well. "I'm not asking for the best care in the world, but just something,'' he says. "We all should receive care without having to fight to survive.''